Academic Dysfunction Following Concussion

At 1 week postinjury, high school and college students with concussions scored significantly higher on an academic dysfunction measure compared with youth with extremity injuries.

Studies of the academic effect of concussion are limited by lack of a comparison group experiencing health effects from other kinds of injuries. In the current study, investigators prospectively enrolled adolescents and college students visiting one of three emergency departments within 24 hours after suffering a sports-related concussion or musculoskeletal extremity injury. During telephone interviews 1 week and 1 month after the injury, participants completed a 29-item academic dysfunction questionnaire (higher score reflecting more dysfunction; maximum score, 174).

Of 204 students agreeing to participate, 176 completed the first interview (mean age, 16 years; 66% males) and 153 the second; approximately 40% of participants at each time point had experienced concussion. Compared with students with extremity injuries, those with concussions took longer to return to school (mean days, 5.4 vs. 2.8) and, after adjusting for history of attention-deficit/hyperactivity disorder, grade point average, and prior concussions, scored 16 points higher on the dysfunction scale at 1 week postinjury. By 1 month, the difference in scores was negligible. Between-group differences in scores at 1 week were greater for female students versus males and students with ≥2 versus <2 prior concussions; at 1 month, a history of ≥2 concussions was the only significant predictor of between-group differences in scores.


By including a comparison group of students with sports-related extremity injuries serious enough to warrant an emergency department visit, this study helps tease out the academic effect of concussions specifically versus injuries overall. It is reassuring that healing occurred by 1 month, but depending on the point in the academic semester or year at which the injury occurs, even a few weeks can have a significant negative impact on academic success. These findings confirm prior work showing that girls and students with multiple prior concussions will need more careful follow-up by pediatricians and school officials.

Alain Joffe, MD, MPH, FAAP reviewing Wasserman EB et al. Am J Public Health 2016 Jul.


Wasserman EB et al. Academic dysfunction after a concussion among US high school and college students. Am J Public Health 2016 Jul; 106:1247.
[PubMed® abstract]

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